Showing papers by "Shahid Beheshti University of Medical Sciences and Health Services published in 2008"

OCT4 spliced variants are differentially expressed in human pluripotent and nonpluripotent cells.

Abstract: OCT4 is a master regulator of self-renewal in embryonic stem cells and can potentially encode two spliced variants, designated OCT4A and OCT4B. We have examined the expression pattern of these OCT4 isoforms in various human pluripotent and nonpluripotent cells. Our data revealed that whereas OCT4A expression is restricted to embryonic stem (ES) and embryonal carcinoma (EC) cells, OCT4B can be detected in various nonpluripotent cell types. Furthermore, we detected a novel OCT4 spliced variant, designated OCT4B1, that is expressed primarily in human ES and EC cells and is downregulated following their differentiation. We also found a significantly higher level of OCT4B1 expression in stage-specific embryonic antigen-3 (SSEA3)(+) compared with SSEA3(-) subpopulations of cultured ES cells. Taken together, our data demonstrated a distinctive expression pattern for OCT4 spliced variants in different cell types and highlight the necessity of defining the type of OCT4 when addressing the expression of this gene in different human cells.

Tramadol intoxication: a review of 114 cases.

Abstract: Tramadol as a centrally acting analgesic is extensively used in the management of moderate to severe pain. It slightly affects opioid receptors and inhibits the reuptake of norepinephrin and serotonin in the CNS. There are reports about toxicity and abuse of tramadol. The objective of the present study was to evaluate epidemiology of intentional tramadol intoxications. All poisoning cases that admitted to Loghman-Hakim Hospital Poison Center from April to May 2007 were studied. A total of 114 cases (82 men and 32 women) of intentional tramadol intoxications with the median age of 23.66 +/- 6.87 years (range 16-54 years) were identified. Other illicit drugs were found to be used in combination with tramadol in some of the cases, which among them benzodiazepines were the most common. Tramadol overdose has been one of the most frequent causes of drug poisoning in the country in the recent years, especially in male young adults with history of substance abuse and mental disorders. Nausea, vomiting, Central Nervous System (CNS) depression, tachycardia, and seizure are the most common findings in this kind of poisoning. Cardiopulmonary arrest was found as the cause of death in cases who had ingested more than 5000 mg tramadol.

Intravitreal bevacizumab with or without triamcinolone for refractory diabetic macular edema; a placebo-controlled, randomized clinical trial.

Abstract: Purpose To evaluate the effect of three intravitreal injections of bevacizumab (IVB) alone or combined with triamcinolone (IVT) in the first injection for treatment of refractory diabetic macular edema (DME).

Colorectal cancer in Iran: an epidemiological study.

Abstract: Background Colorectal cancer (CRC) is one of the most common cancers worldwide. But information regarding CRC in Iran is limited; the aim of this study was to investigate the epidemiologic features of CRC in Iran, using 5-year data from cancer registry. Methods This survey is a descriptive-analytic study consists of 1138 colorectal cancer patients who registered in Cancer Registry Center of Research Center for Gastroenterology and Liver Disease, Tehran, Iran. These data gathered using interview and pathology reports that registered in cancer registry forms. Data analysis was performed with descriptive and univariate methods. Results Of 1138 patients, 696 cases were male and 442 female. There was no significant difference between males and females regarding age at diagnosis. 400 patients (35.1%) had a family history of cancer. The most common histology type of tumor was adenocarcinoma, NOS. In most cases (39.1%) tumor grading was well differentiated and there was no significant difference between males and females. Conclusion Colorectal cancer is a disease with nonspecific symptoms. Family history of cancer was evident in 35.1% of our cases and also 42.9% of patients were below the age of 50 years old, suggests that genetic factors may be play an important role in the development of this disease in our country.

Marrow-derived mesenchymal stem cells-directed bone regeneration in the dog mandible: a comparison between biphasic calcium phosphate and natural bone mineral.

Abstract: Objective This study was designed to compare mesenchymal stem cell (MSC)-based alveolar bone regeneration in biphasic bone substitutes and natural bone mineral in a canine full-thickness alveolar defect model. Materials and methods MSCs were isolated from bone marrow aspirates and culture expanded through 3 successive subcultures. The bone differentiation potential of third passage cells was evaluated and confirmed in vitro before cells were used in the transplantation experiment. Undifferentiated cells were then incubated with 3 × 3 × 3 mm 3 hydroxyapatite/β-tricalcium phosphate (HA/TCP) matrices (Kasios, Lanauguet, France) and 1- to 2-mm Bio-Oss spongiosa (Geistlich Biomaterials, Osteohealth, Switzerland), which is a natural bovine bone mineral (NBM). Kasios/cell, Kasios alone, Bio-Oss/cell, and Bio-Oss alone were implanted in masseter muscle and 4 cylindrical (10-mm diameter) through-and-through bilateral mandibular body defects in 4 mongrel dogs. Histomorphometric analysis was performed 6 weeks after insertion of the scaffold loaded with MSCs. Results H&E staining of the decalcified scaffold and scanning electron microscopy demonstrated large MSC coverage of the HA/TCP and Bio-Oss. Cell-loaded Kasios matrices showed the greatest amount of the bone regeneration among the groups in both the muscle (29.11%) and the bone specimens (65.78%). Cell-free biphasic scaffold revealed 44.9% bone fill in bone defects and 23.55% in muscle specimen, and Bio-Oss alone matrices had the least amount of new bone formation: 36.84% and 24.16% in bone and muscle specimens respectively. Kasios loaded with MSCs demonstrated more bone regeneration than Bio-Oss/cell but there was no significant statistical difference ( P > .05). Conclusions New biphasic synthetic bone substitutes may offer better conditions for bone regeneration than traditional bone substitute in combination with MSCs. They remained in the defect and contributed to bone regeneration.

Prognostic factors in 1,138 Iranian colorectal cancer patients

Abstract: The incidence of colorectal cancer is increased in Iran in recent years and colorectal cancer is the fourth most common cancer in both sexes. The aim of this study is to define the prognostic factors in Iranian colorectal cancer patients using univariate and multivariate methods. All patients with colorectal cancer diagnosis according to the pathology report that registered in our cancer registry center in the period between Jan 2002 until Jan 2007 were eligible for this study. These patients were followed up by telephone contact. The probability curves for survival were calculated according to the Kaplan–Meier method and compared by the Log-rank test. Multivariate analysis was carried out using the Cox proportional hazard model. Of 1,138 cases, a survival information was available on 1,127 patients, 690 males (61.2%) and 437 females (38.8%). Mean survival time was 105.1 (CI: 95.1–115.1) months. The Kaplan–Meier method indicated that the 1, 3, 5, 7, 10, and 15 years of survival rates are 91.1%, 73.1%, 61.0%, 54.9%, 47.9%, and 25.9%, respectively. According to the univariate analysis, the factors influencing overall survival rate were the following: type of first treatment, body mass index, marital status, tumor grade, extent of wall penetration, distant metastasis, regional lymph nodes metastasis, and pathologic stage of tumor. The following five variables were independent prognostic factors for survival as determined by multivariate analysis: tumor size, metastasis of tumor, body mass index, marital status, and grade of tumor. Our results showed that stage of tumor, distant metastasis, grade of tumor, and tumor size should be considered as the most important prognostic factors in colorectal cancer patients.

Mesenchymal stem cells enhance bone regeneration in rat calvarial critical size defects more than platelete-rich plasma.

Abstract: Objective The objective of this study was to compare culture-expanded bone marrow–derived mesenchymal stem cell and PRP loaded to natural bone mineral (Bio-Oss) and β-TCP for rat calvarial bone repair. Methods Twenty-two adult male Sprague-Dawley rats were randomly divided into 2 groups (n = 11). In the first group, 2 calvarial defects, 5 mm in diameter, were prepared in the parietal bone. The left defect was filled with Bio-Oss plus PRP while the right defect was filled with mesenchymal stem cell cultured on Bio-Oss. Kasios as a bone substitute was replaced in the second group. The animals were humanely killed 6 weeks postsurgery and the amount of the bone regeneration evaluated using histometric analysis. Result The bone fill length in the calvarial defect had statistically significant difference with other groups ( P Conclusions New synthetic bone substitutes may offer a better condition for bone regeneration compared to the traditional bone substitute in combination with mesenchymal stem cells. They remained in the defect and contributed bone regeneration. The use of the mesenchymal stem cell in conjunction with bone substitutes can enhance bone regeneration more than PRP.

Hyperglycemia in acute aluminum phosphide poisoning as a potential prognostic factor.

Abstract: Aluminum phosphide (AlP) is a solid fumigant widely used in Iran as a grain preservative. When reacted with water or acids, AIP produces phosphine gas, a mitochondrial poison that interferes with oxidative phosphorylation and protein synthesis. Poisoning by AIP is one of the most important causes of fatal chemical toxicity in Iran. There are few studies in the medical literature addressing prognostic factors associated with AlP poisoning. In this prospective study conducted across a 14-month period commencing on 21st March 2006, we enrolled all patients admitted to the ICU of Loghman-Hakim Hospital Poison Center (Tehran, Iran) with AIP poisoning, no history of diabetes mellitus diagnosed before hospitalization, and normal body mass index. We recorded patient-specific demographic information, blood glucose level on presentation (before treatment), arterial blood gas (ABG) analysis, time elapsed between ingestion and presentation, ingested dose, duration of intensive care admission, and outcome data related to each presentation. We enrolled the group of patients who survived the intoxication as a control group and compared their blood glucose levels with those who died because of AlP poisoning. Data were analyzed by Statistical Product and Service Solutions (SPSS) software (Version 12; Chicago, Ilinois, USA) using logistic regression, Pearson correlation coefficient and Student's t-test. P values of 0.05 or less were considered as the statistical significant levels. Forty-five patients (21 women and 24 men) with acute AlP poisoning were included in the study. The mean age was 27.3 +/- 11.5 years (range: 14-62 years). Thirteen patients survived (29%) and 32 expired (71%). AlP poisoning followed deliberate ingestion in all patients. The time elapsed between ingestion and arrival at the hospital was 3.2 +/- 0.4 h. There was no significant difference between survived and non-survived groups according to age, gender, and time to treatment. However, the difference between mean blood glucose levels in survived (143.4 +/- 13.7 mg/dL) and non-survived (222.6 +/- 20 mg/dL) cases was statistically significant (P = 0.021). There was no significant correlation between blood glucose level and time to treatment, age, gender, pH, HCO3 concentration, and ingested dose. Twenty-three (71.9%) of non-survived and four (30.8%) of survived patients had a blood glucose level greater than 140 mg/dL. After adjusting according to age, gender, ingested dose, pH and HCO3 concentration The odds ratio for hyperglycemia as a risk factor for death was 5.7 (CI of 1.4-23.4). In our study, patients who succumbed to AIP poisoning had significantly higher mean blood glucose levels than those who survived. This correlation of hyperglycemic effect and mortality suggests that it may be useful in guiding risk assessment and treatment of AIP poisoning. Management of hyperglycemia may have a useful role in treatment of these patients by allowing increased entrance of glucose into cells and reducing oxygen consumption.

Cataracts in Diabetic Patients: A Review Article

Abstract: The number of people with diabetes mellitus is increasing and cataracts are one of the most common causes of visual impairment in these subjects. Advances in cataract surgical techniques and instrumentation have generally improved the outcomes; however,surgery may not be safe and effective in certain individuals with pre-existing retinal pathology or limited visual potential. This review article aims to address different aspects surrounding cataracts in diabetic patients. In a computerized MEDLINE search,relevant studies were selected by two authors using the keywords "diabetes mellitus", "cataract", "diabetic retinopathy" and "diabetic maculopathy".

Effect of Ramadan fasting on some indices of insulin resistance and components of the metabolic syndrome in healthy male adults.

Abstract: The purpose of the present study was to evaluate the effect of Ramadan fasting on insulin sensitivity in subjects with the metabolic syndrome. Males (n 55; age 34·1 (SD 8·9) years) with the metabolic syndrome were studied. Blood pressure, waist circumference, body weight, HDL-cholesterol (HDL-C), TAG, fasting plasma glucose (FPG), fasting blood insulin and insulin resistance indices (quantitative insulin sensitivity check index (QUICKI), homeostasis model assessment of insulin resistance (HOMA-IR) and reciprocal index of HOMA-IR (1/HOMA-IR)) were evaluated before and after 30 d of Ramadan fasting (two meals at 12 h intervals). The dietary intake was estimated by 24 h recall before and after fasting. The total daily energy intake was decreased by 234·6 (SD 88·2) kJ/d in the fasting period (P¼ 0·005). 1/HOMA-IR, QUICKI and HDL-C were significantly increased (P¼ 0·005, P¼0·001 and P¼ 0·004) and FPG significantly decreased (P,0·005) after fasting. Simple linear regression analysis demonstrated that HOMA-IR, 1/HOMA-IR and QUICKI were related to waist circumference after intervention (r 0·458, P, 0·001; r 20·396, P, 0·05; r 20·342, P,0·05). In conclusion, the present study showed that the combined change in the number and timing of meals and portioning of the entire intake into only two meals per d may increase insulin sensitivity in subjects with the metabolic syndrome even when the decrease in energy consumption is minimal. Insulin sensitivity: Ramadan fasting: Metabolic syndrome: Homeostasis model assessment: Quantitative insulin sensitivity check index

Corneal endothelial cell injury induced by mitomycin-c in photorefractive keratectomy: nonrandomized controlled trial

Abstract: Purpose To evaluate the effect of intraoperative use of mitomycin-C (MMC) on the corneal endothelium during excimer laser photorefractive keratectomy (PRK). Setting Vanak Eye Surgery Center, Tehran, Iran. Methods This nonrandomized trial comprised 81 patients (162 eyes) with bilateral low to moderate myopia and adequate corneal thickness to allow PRK (estimated postoperative residual stromal thickness >350 μm without considering epithelial thickness). The indication for intraoperative application of MMC 0.02% (0.2 mg/mL) was an ablation depth of 75 μm or more. Patients were divided into 3 groups: bilateral (both eyes treated with MMC), unilateral (only 1 eye treated with MMC), and untreated (no eye treated with MMC). Visual acuity, refraction, endothelial cell density (ECD), and corneal thickness were measured preoperatively as well as 1 week and 1, 3, and 6 months postoperatively. Results Overall, 76 eyes were treated with MMC. Eyes treated with MMC and untreated eyes were comparable in postoperative visual acuity and refraction. Preoperative to postoperative changes in ECD were statistically significantly greater in the treated eyes (−14.8%) than in untreated eyes (−5.1%) 6 months after PRK ( P .001). Longer MMC contact time ( P P = .04) were the only factors independently associated with greater endothelial cell loss. Conclusions The prophylactic use of diluted intraoperative MMC 0.02% solution caused corneal endothelial cell loss. The rate of cell loss was correlated with the duration of MMC exposure.

Computational modelling of a non-viscous fluid flow in a multi-walled carbon nanotube modelled as a Timoshenko beam

Abstract: In the design of nanotube-based fluidic devices, a critical issue is the effect of the induced vibrations in the nanotube arising from the fluid flow, since these vibrations can promote structural instabilities, such as buckling transitions. It is known that the induced resonant frequencies depend on the fluid flow velocity in a significant manner. We have studied, for the first time, the flow of a non-viscous fluid in stubby multi-walled carbon nanotubes, using the Timoshenko classical beam theory to model the nanotubes as a continuum structure. We have obtained the variations of the resonant frequencies with the fluid flow velocity under several experimentally interesting boundary conditions and aspect ratios of the nanotube. The main finding from our work is that, compared to an Euler-Bernoulli classical beam model of a nanotube, the Timoshenko beam predicts the loss of stability at lower fluid flow velocities.

Surveillance and laboratory detection system of Crimean-Congo haemorrhagic fever in Iran.

Abstract: Crimean-Congo haemorrhagic fever (CCHF) is a viral zoonotic disease with a high mortality rate in humans. The CCHF virus (CCHFV) is transmitted to humans through the bite of Ixodid ticks or by contact with blood or tissues of infected livestock. In addition to zoonotic transmission, CCHFV can be spread from person to person and is one of the rare haemorrhagic fever viruses able to cause nosocomial outbreaks in hospitals. Crimean-Congo haemorrhagic fever is a public health problem in many regions of the world such as Eastern Europe, Asia, the Middle East and Africa. In addition to clinical symptoms, the diagnosis of CCHF is based on the use of serological tests for the detection of immunoglobulin M and immunoglobulin G antibodies and on the use of molecular tools such as RT-PCR. From 1970 to 1978, serological and epidemiological studies were performed in humans and in livestock of Iran. After two decades and observations of CCHF in some provinces of Iran, a CCHF surveillance and detection system was established in 1999, leading to a dramatically decreased mortality rate from 20% (year 2000) to 2% (year 2007).

Evaluation of PCR assay in diagnosis and identification of cutaneous leishmaniasis: a comparison with the parasitological methods.

Abstract: The aims of this study are to identify Leishmania species and compare and validate internal transcribed spacers (ITS) polymerase chain reaction (PCR) assay against parasitological methods for diagnosing cutaneous leishmaniasis (CL). We used the ITS-PCR, parasite culture, and microscopic evaluation of stained smears on 155 specimens from suspected cases of (CL) patients who referred to Mashhad Health Centers (northeast Iran). The PCR indicated the sensitivity (98.8%), correctly diagnosing 86 of the 87 confirmed positive specimens. Microscopy and parasite culture alone showed 79.3% sensitivity (69/87 positive) and 86.2% sensitivity (75/87 positive), respectively, while microscopy and culture in combination improved sensitivity totally to 100% (87/87). The results also revealed that Leishmania tropica species is dominant (96.5%) in the studied regions. This study suggests that both the parasitological techniques reliably were used for the diagnosis of CL, and the ITS-PCR assay without using RFLP analysis is useful for identifying Leishmania species in the area.

Revisiting blood transfusion preparedness: experience from the Bam earthquake response.

Abstract: Blood transfusion plays a critical role in the provision of medical care for disasters due to man-made and natural hazards. Although the short-term increase in blood donations following national disasters is well-documented, some aspects of blood transfusion during disasters remain under study. The 2003 earthquake in Bam, Iran resulted in the death of >29,000 people and injured 23,000. In total, 108,985 blood units were donated, but only 21,347 units (23%) actually were distributed to hospitals around the country. Kerman Province, the site of the disaster, received 1,231 (1.3%) of the donated units in the first four days after the disaster. The Bam experience revealed crucial missteps in the development of a post-event strategy for blood product management, and led to the development of a detailed disaster preparedness and response plan that addresses issues of donation, distribution, communication, transportation, and coordination. The current plan requires the Iranian Blood Transfusion Organization to convene a disaster task force immediately as the main coordinator of all disaster preparedness and response activities.

Fatal intoxication with imidacloprid insecticide.

Abstract: Imidacloprid [1-(6-chloro-3-pyridylmethyl)-N-nitroimidazolidin-2-ylideneamine, CAS 138261-41-3] belongs to a relatively new class of insecticidal chemistry, the chloronicotinyl neonicotinoid compounds. Animal studies indicate relatively low toxicity to mammals. Despite wide usage in some countries, the understanding of human poisoning is quite limited. Here we report a fatal case of rapid ingestion of an insecticide formulation containing imidacloprid. Clinical manifestation included severe vomiting, hypertension, tachycardia, mydriasis with sluggish reaction to light, and loss of consciousness. In the course of toxicity, the patient manifested bradycardia, bradypnea, and cardiopulmonary arrest and death. Because moderate- to high-dose imidacloprid in animals causes central nervous system activation similar to nicotine, including tremors, impaired papillary function, and hypothermia, it is more likely that the formulation ingredients caused most of the clinical symptoms including central nervous system depression and gastrointestinal irritation. Language: en

Antibody Response to Influenza Immunization in Kidney Transplant Recipients Receiving either Azathioprine or Mycophenolate: A Controlled Trial

Abstract: Aims: We aimed to assess humoral immune response to the influenza vaccine in adult kidney transplant recipients (KTRs) subjected to two immunosuppressive regimens containing either

Laparoscopic anatrophic nephrolithotomy for managing large staghorn calculi.

Abstract: OBJECTIVES To evaluate the efficacy of a laparoscopic approach for managing large staghorn renal calculi. PATIENTS AND METHODS Laparoscopic transperitoneal anatrophic nephrolithotomy was used to duplicate open anatrophic nephrolithotomy in five patients (three men) with large staghorn renal stones unsuitable for percutaneous nephrolithotomy. Only the renal artery was clamped, using a bulldog clamp. The stone was removed through a nephrotomy incision on the Brodel line, which was closed using 3/0 polyglactin continuous sutures, and sutures were buttressed by haemostatic clips instead of knots. Intraoperative ultrasonography was used in the last two patients to evaluate residual stones. RESULTS The mean (range) stone size was 53 (45–65) mm, the patient age was 53 (45–58) years, and the warm ischaemia and operative duration were 32 (29–35) and 170 (120–225) min, respectively. No blood transfusion was needed during or after surgery. All of the procedures were uneventful and there was no urine leakage after surgery. Only an 8-mm and a 6-mm residual stone remained in the first and third patients, in the lower and middle calyces, respectively. Both of them were subsequently treated with shock wave lithotripsy. An intravenous pyelogram after surgery showed a functional corresponding renal unit, with a significant improvement in obstruction in all patients. CONCLUSION Laparoscopic anatrophic nephrolithotomy is a promising alternative for patients who are candidates for open surgery, with an acceptable stone-free rate. While offering a minimally invasive approach, it can minimize the need for secondary invasive interventions. Further patients and a longer follow-up are needed before this is suggested as the preferred method in selected patients in the future.

Unintentional poisoning by phosphine released from aluminum phosphide.

Abstract: Aluminum phosphide as a releaser of phosphine gas is used as a grain preservative. In this case report, we describe an accidental severe poisoning in a 35-year-old woman, her 18-year-old daughter, and 6-year-old son caused by inhalation of phosphine gas released from 20 tablets of aluminum phosphide stored in 15 rice bags. The boy died 2 days after exposure before admission to hospital and any special treatment, but the others were admitted 48 h after exposure. They had signs and symptoms of severe toxicity, and their clinical course included metabolic acidosis, electrocardiographic changes, and hypotension. They were treated by intravenous administration of sodium bicarbonate, magnesium sulfate, and calcium gluconate. The patients were discharged after 3 days and followed up for 1 week after discharge. Rapid absorption of phosphine by inhalation, induction of hyperglycemia, and surviving of patients are interesting issues of this case report.

Outcome of treatment of MDR-TB patients with standardised regimens, Iran, 2002-2006.

Abstract: CONTEXTE : La tuberculose multiresistante (TB-MDR) represente un fardeau effroyable pour les systemes nationaux de sante. Aucun consensus n'existe encore sur le sujet et des controverses persistent concernant les protocoles de traitement, les resultats du traitement et les divers regimes. METHODES : Cette etude rapporte les resultats du traitement de la TB-MDR dans la deuxieme cohorte nationale d'Iran. Cette etude implique tous les cas documentes de TB-MDR en Iran et referes vers notre centre au cours de la periode 2002-2006. Tous les patients ont recu un regime standardise de deuxieme ligne qui a consiste uniformement en ofloxacine, cycloserine, prothionamide et amikacine. L'ethambutol et le pyrazinamide ont ete ajoutes au regime en se basant sur les tests de sensibilite aux medicaments. RESULTATS : Au total, 43 patients atteints de TB-MDR ont ete inclus dans le traitement. Parmi eux, 27 (62,8%) etaient des hommes ; l'âge moyen etait de 44,38 ± 19,05 ans. Vingt-trois d'entre eux (53,5%) etaient Iraniens et les autres Afghans. Tous les patients etaient des cas de TB-MDR secondaire. Sur le total de 43 cas, 25 (58,1%) ont souffert d'effets indesirables majeurs et de signification clinique. Vingt-neuf (67,5 % ) ont eu un resultat couronne de succes. A l'inverse, au total 14 (32,5%) ont eu un resultat mediocre (echec du traitement chez six [14%] et deces chez huit [18,6%]). La mortalite a ete plus elevee chez les Iraniens (P = 0,039) et chez les patients dont le regime initial a du etre modifie par suite de reactions indesirables a l'egard des medicaments (P = 0,01). CONCLUSION : Dans notre etude, les resultats du traitement de la TB-MDR par un regime standardise ont ete favorables par comparaison avec ceux des etudes anterieures.

Methylmalonic acidemia: brain imaging findings in 52 children and a review of the literature

Abstract: Methylmalonic acidemia (MMA) is an autosomal-recessive inborn error of metabolism. To recognize the CT and MR brain sectional imaging findings in children with MMA. Brain imaging studies (47 MR and 5 CT studies) from 52 children were reviewed and reported by a neuroradiologist. The clinical data were collected for each patient. The most common findings were ventricular dilation (17 studies), cortical atrophy (15), periventricular white matter abnormality (12), thinning of the corpus callosum (8), subcortical white matter abnormality (6), cerebellar atrophy (4), basal ganglionic calcification (3), and myelination delay (3). The brain images in 14 patients were normal. Radiological findings of MMA are nonspecific. A constellation of common clinical and radiological findings should raise the suspicion of MMA.

Clinical and epidemiologic features of Crimean-Congo hemorrhagic fever among children and adolescents from southeastern Iran.

Abstract: :This study aimed to investigate the clinical and epidemiologic features of Crimean-Congo hemorrhagic fever among 34 children and adolescents (mean age, 13.3 ± 4.6 years) from a highly endemic region. Clinical manifestations were similar to those in adults. The case-fatality ratio was 26.5%